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Would You Trust An Unhealthy And Unfit Cardiologist?

There was a very controversial presentation made at a recent meeting of heart doctors in Canada. I’ve been stewing about what to say about it for a week.

The title speaks to its inflammation:

Fat, unfit, unmotivated: Cardiologist, heal thyself

The presenter that made the stir, pediatric cardiologist, and IronPerson, Dr. Brian McCrindle (Toronto) argued that overweight, unfit doctors are doing their patients a disservice. His bottom line: cardiologists are acting like the rest of Western society. They are not living a healthy lifestyle.

He made three major points. (in-depth coverage can be viewed here, on TheHeart.org)

*This blog post was originally published at Dr John M*

Food Truths, Food Lies: Final Nutrition Advice For The Boys & Girls Club’s Fit Family Challenge

Over the past 6 weeks, 5 families (selected by the Boys & Girls Clubs) have been working hard to develop new healthy eating and exercise patterns (part of The Triple Play Fit Family Challenge). Their ultimate goal is to maintain these habits for a lifetime, and teach their peers to follow in their footsteps. Next week I’ll be traveling to Los Angeles to meet the families and participate in the awards ceremony – where the winning family will receive an all expense paid vacation. (Maybe if I play my cards right they’ll take me with them? One can always dream…)

I myself have been challenged to encapsulate all the best nutrition research into simple guidelines for daily living. I gave it my best shot in this blog post, and today I’m going to review some final food philosophy, straight from one of my favorite books, Food Truths, Food Lies.

Food Truths:

  1. Calories matter most – food is like fuel. It is burned for energy, and when we have reached our daily calorie needs, the rest is stored as fat. Some food is more calorie-dense than others, but the bottom line is that to maintain our weight we need to balance calories in (what we eat) with calories out (what we burn through activities of daily living and/or exercise).
  2. You can’t exercise your way to weight loss. In other words, you can’t outrun your mouth. Just think about it Read more »

The Cutest Nutrition Video Ever: Introducing The Porter Family

As my regular readers already know, I’ve been eagerly coaching the Boys & Girls Clubs’ Triple Play Fit Family Challenge (FFC) participants on healthy eating. During a recent phone call with the families I expressed some wistfulness about not being able to *see* what they’ve been eating (the FFC blog is filled with charming action shots of the families exercising, but almost no food cameos). And this is what the Porter family just sent me. It’s a video inviting me to a dinner of grilled tilapia, brown rice, acorn squash, mushrooms and broccoli. Tell me if this isn’t the cutest nutrition video ever?

A Healthy, Affordable, Home-Cooked Meal In Under Nine Minutes?

In my recent phone chat with the Boys & Girls Clubs participants of the Fit Family Challenge, one of the callers confided in me that she works long hours and struggles to find time to cook healthy meals for her family. This is a very common problem, though there are tricks to make meal preparation fast and affordable. I decided to take the challenge myself, cooking a pork chop dinner for three, with only 9 ingredients in 9 minutes. I took a photo of the starting ingredients here. The total cost of the used portions (I’m not counting all the PAM, and apple sauce that I didn’t use for example) was about $9. That’s only $3 per person, less than most fast food meals! (I served ice water with the meal, but a glass of skim milk would have been fine too.)

My ingredients include:

1. Quick-fry pork chops, seared in a pan coated with PAM cooking spray. I chose pork chops with very little fat, and cooked them for 4 minutes on each side. Read more »

8 Tips For Healthy Meal Preparation

As I’ve been coaching the families in the Boys & Girls Clubs’ Triple Play Fit Family Challenge I’ve received some excellent questions about how to modify food preparation to make meals more healthful. I thought I’d share some of my nutrition tips on my blog – and feel free to chime in as well in the comments section! (Please note that I have no relationship with the manufacturers of the products I mention below. I happen to like and use them, but I’m sure there are many others that are good.) Here’s what I told one of the families:

At first it’s hard to make the switch to “healthy” cooking because let’s face it, fat and sugar taste so good. However, there are ways to substitute healthier choices that are delicious too. And over the long haul, you can actually change your taste buds so that they LIKE lower-fat options. It seems unbelievable, but honestly – I have learned to prefer sugar-free peanut butter, whole grain bread, and skinless chicken to the regular stuff. One thing I will say, though, is that as long as no one has any high blood pressure or kidney problems – salt is ok. I think too much has been made about the “dangers” of salt. Healthy bodies can easily get rid of extra salt… so no need to torture yourself with a low salt diet. If you cut out junk food and fast food, your salt intake will likely fall to healthy levels. ;-)

Here are general tips for healthy eating:

Read more »

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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